Thursday, 9 August 2018

Tutorial 9th. August 2018




11
Viva. Labour ward scenario 1.
12
Role-play. Explain normal labour and delivery.
13
Role-play. Hydatidiform mole.
14
Viva. Obstructive sleep apnoea

11.   Labour ward scenario.
You are the registrar on duty and responsible for the labour and gynae wards. You have just had the handover. Your task is to discuss the overall management of the wards with the examiner, to prioritise the patients and decide the allocation of staff to see them.

Sunday 13.00 hours.
Labour Ward.
1
Mrs JH
Primigravida. T+8. In labour. 6 cms.
2
Mrs AH
Primigravida at T. In labour. 5 cms.
3
Mrs. BH
Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
4
Mrs SB
Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan.
5
Mrs KW
Para 1. In labour. Cx. 5 cm. Ceph at spines.
6
Mrs KT
Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
7
Mrs TB
Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Type 1 decelerations.
8
Mrs RJ
Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours.
9
Mrs KC
Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral.
Gynaecology ward.
8 major post operative cases who have been seen on the morning ward round and are stable. Husband of patient who has had Wertheim's hysterectomy asking to see a doctor for a report on the operation.
1
Mrs JB
10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
2
Ms AS
19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst.
Medical staff:
Consultant at home. Registrar - you.
Senior House Officer with 12 months experience.
Registrar in Anaesthesia.
Consultant Anaesthetist on call at home.
Midwifery staff:
Senior Sister.                 Trained to take theatre cases. Able to site IV infusions and suture episiotomies and tears.
3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions.
1 Community midwife looking after Mrs. KW.
2 Pupil Midwives.

12.   Normal labour and delivery.
Candidate’s instructions.
You are the SpR on call for the delivery unit. It is unusually quiet. The on-call consultant has asked you to explain normal labour and delivery to a medical student who started with the department yesterday.

13.   Hydatidiform mole.
Candidate's Instructions.
You are the SpR in the gynae clinic. The consultant has said that it will be a good experience for you to see the next patient. She was recently an inpatient for evacuation of retained products after an apparent miscarriage at 8 weeks. The histology report showed a complete mole. The GP was contacted and asked to see her. An appointment was sent to her to attend today. Your task is to take a history and explain the implications of the diagnosis.

14.  Obstructive sleep apnoea.
Candidate's Instructions.
This is a viva station, now called a ‘structured discussions’. The examiner will ask you 11 questions.
When you have answered a question and moved to the next, you are not allowed to return as later questions may give answers to earlier ones.


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